WHO has released its fresh recommendation
to establish global care standards for healthy pregnant women and reduce
unnecessary medical interventions.The new WHO guideline recognizes that every
labour and childbirth is unique and that the duration of the active first stage
of labour varies from one woman to another. In a first labour, it usually does
not extend beyond 12 hours. In subsequent labours it usually does not extend
beyond 10 hours. The guideline emphasizes that a slower cervical dilation rate
alone should not be a routine indication for intervention to accelerate labour
or expedite birth.
Worldwide, an estimated 140 million births take
place every year. Most of these occur without complications for women and their
babies. Yet, over the past 20 years, practitioners have increased the use of
interventions that were previously only used to avoid risks or treat
complications, such as oxytocin infusion to speed up labour or caesarean
sections.
“We want women to give birth in a safe
environment with skilled birth attendants in well-equipped facilities. However,
the increasing medicalization of normal childbirth processes are undermining a
woman’s own capability to give birth and negatively impacting her birth
experience,” says Dr Princess Nothemba Simelela, WHO Assistant Director-General
for Family, Women, Children, and Adolescents.
“If labour is progressing normally, and the woman
and her baby are in good condition, they do not need to receive additional
interventions to accelerate labour,” she says.
Childbirth is a normal physiological process that
can be accomplished without complications for the majority of women and babies.
However, studies show a substantial proportion of healthy pregnant women
undergo at least one clinical intervention during labour and birth. They are
also often subjected to needless and potentially harmful routine interventions.
The new WHO guideline includes 56 evidence-based
recommendations on what care is needed throughout labour and immediately after
for the woman and her baby. These include having a companion of choice during
labour and childbirth; ensuring respectful care and good communication between
women and health providers; maintaining privacy and confidentiality; and
allowing women to make decisions about their pain management, labour and birth
positions and natural urge to push, among others.
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Every labour is unique
and progresses at different rates
To reduce unnecessary medical interventions, the
WHO guideline states that the previous benchmark for cervical dilation rate at
1 cm/hr during the active first stage of labour (as assessed by a partograph or
chart used to document the course of a normal labour) may be unrealistic for
some women and is inaccurate in identifying women at risk of adverse birth
outcomes. The guideline emphasizes that a slower cervical dilation rate alone
should not be a routine indication for intervention to accelerate labour or
expedite birth. “Many women want a natural birth and prefer to rely on their
bodies to give birth to their baby without the aid of medical intervention,”
says Ian Askew, WHO Director, Department of Reproductive Health and Research.
“Even when a medical intervention is wanted or needed, the inclusion of women
in making decisions about the care they receive is important to ensure that
they meet their goal of a positive childbirth experience.”
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High-quality care for all women
Unnecessary labour interventions are widespread
in low-, middle- and high-income settings, often putting a strain on already scarce
resources in some countries, and further widening of the equity gap.
As more women give birth in health facilities
with skilled health professionals and timely referrals, they deserve better
quality of care. About 830 women die from pregnancy- or childbirth-related
complications around the world every day – the majority could be prevented with
high-quality care in pregnancy and during childbirth.
Disrespectful and non-dignified care is prevalent
in many health facilities, violating human rights and preventing women from
accessing care services during childbirth. In many parts of the world, the
health provider controls the birthing process, which further exposes healthy
pregnant women to unnecessary medical interventions that interfere with the
natural childbirth process.
Achieving the best possible physical, emotional,
and psychological outcomes for the woman and her baby requires a model of care
in which health systems empower all women to access care that focuses on the
mother and child.
Health professionals should advise healthy
pregnant women that the duration of labour varies greatly from one woman to
another. While most women want a natural labour and birth, they also
acknowledge that birth can be an unpredictable and risky event and that close monitoring
and sometimes medical interventions may be necessary. Even when interventions
are needed or wanted, women usually wish to retain a sense of personal
achievement and control by being involved in decision making, and by rooming in
with their baby after childbirth.
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